Higher surgical volumes are associated with improved perioperative outcomes for vestibular schwannomas

Surgical resection remains a primary treatment for vestibular schwannomas (VS). In neuro-oncology, surgical outcomes tend to be better at higher volume centers, but this remains understudied for VS. This study aims to investigate the association of hospital neurosurgical volume with perioperative VS outcomes.

The National Inpatient Sample (NIS) database was queried from 1998 to 2014 for patients undergoing VS resection. Hospitals were classified by quartile of annual surgical VS volume across the study period. Odds ratios (OR) were calculated using a logistic regression model with covariates assessed to be clinically relevant.

Patients in the highest quartile of VS resection surgical volume had a lower rate of overall complications (29.4 % vs. 50.2 %, p < 0.001), including neurosurgical complications (26.1 % vs. 46.3 %, p < 0.001) when compared to the lowest quartile. The highest quartile had an OR of 0.46 (p < 0.001) for overall complications and 0.43 (p < 0.001) for any neurosurgical complications, compared to the lowest quartile. The highest quartile also had a lower OR for facial paralysis, vocal cord paralysis, and dysphagia. In addition, overall complications decreased as surgical volume increased, with the lowest odds of complications seen in the 30-40 cases/year group.

Hospital neurosurgical volume was inversely related to perioperative surgical and medical complications for patients undergoing VS resection, suggesting surgeons at high volume hospitals may have more experience and skills in performing these surgeries. Long-term investigations are necessary to further quantify the relationship between surgical volume and peri-operative outcomes for patients with VS.